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You are so fortunate to have Dr. Kellerstein as faculty; CCHM is a place for quality study of homeopathic medicine and I refer my chiropractic students to your college for advanced study in homeopathy. I am always so excited when I can touch a student in the chiropractic program to look beyond and seek more about health and healing paradigms. This is not dismissing my own profession but to share the homeopathic bite that took my practice experiences to a higher level.

Ongoing results are presented on a case of painful locomotor issues, in a 91 year-old patient, with tympanic abdomen and vertigo as concomitant symptoms. The patient associates vertigo to an old mechanical trauma (whiplash) which she has controlled over the years with exercise and physiotherapy. However, this symptom has returned in old age and is presently the chief complaint. After the initial consultation, the patient reacted positively to carbo vegetabilis followed by pulsatilla. However, since the vertigo did not ameliorate from any of these remedies, agaricus muscaris has been prescribed with good results for the dizziness but it does not seem to help steadily for the other symptoms.

The patient

Soco is a 91 year-old Mexican lady. She was born and has lived for most of her life in a coastal city in Mexico. She weighs 45 kilograms and is 1.50 m. tall; walks with a stick for short distances and uses a walker when she goes out. She also wears an orthopaedic belt that she removes at night for sleeping. She moved to a senior’s residence on May of last year, by her own choice, because she thought she was becoming a burden for her family. However, some living conditions in the residence as well as the financial situation of her family did not allow her to remain there. Presently she lives with one of her daughters and has a 12-hour health care assistant.

Initial interview | October 2, 2016

At the time of our initial consultation, Soco’s main complaints were general lack of energy, pain in the lumbar and sacral regions with blockage and formication in the legs, abdomen bloating, and a sensation of throbbing in the nape when lying down. Soco has a family history of osteoporosis, inherited scoliosis and eye affections, such as glaucoma, cataracts and pterygium.

On observation, Soco looks frail and small. Her torso is bent to the right and has developed a hump on the left side of her upper back. She follows the conversation with attention and is very articulate when talking about her ailments. Her voice is soft but steady. Her eyes are bright and intelligent, however are clouded by a bluish membrane. She has fidgety hands but not trembling in the limbs.

Main complaints

When I asked the patient which one of her symptoms bothers her the most, she said the lack of energy: “I cannot write anymore because my hand is not steady; I don’t find the strength to read. I used to do embroidery and knitting but I cannot do that anymore. My eyes don’t help anymore. I cannot even help in the kitchen, washing dishes, because all things slip from my hands. Anything that represents effort and concentration is becoming harder and harder for me”. However she still eats by herself and she does not topple down things while sitting at the table.

Soco feels a constant bruising pain in the bones. The gerontologist has prescribed her to walk, and she tries to do it every day, either with the cane or the walker. But sometimes the pain in the bones is so strong that she must go back to bed because sitting aggravates her pain. She does exercise in bed, stretching her legs and her arms, but when she feels energetic she goes to the swimming pool with her walker and does exercises in the water. This type of exercise improves greatly her general state. But since the swimming pool is outdoors, and if the day is windy or cloudy, she prefers not to go because she is afraid of catching cold.

She feels the most intense pain in the area of her hips, which in combination with her constant bloating of the abdomen make her feel quite uncomfortable. She describes the pain in the pelvic area as a blocking pain that prevents her from moving her legs. And the abdominal discomfort is a burning pain. This combination of pain in the sacral area with pain in the abdomen starts in the small of her back and extends to both sides until it covers all her pelvic area “as a wide belt” that doesn’t allow her to move.

She can walk for 30 minutes before experiencing great pain; but the pain is becoming constant since two years ago, approximately. She gets better by lying down, prone or supine, without pillow under the head. She also gets relief from soft massage in the muscles adjacent to the lumbar and sacral region. She actually does not feel pain when someone touches her spine; but there is a high sensitivity to her vertebrae.

When I asked about bone pains somewhere else, she said she has none except the one in the pelvic area. Then she showed me her hands. She has no fingers deformed and no inflammation in the phalanges. She has a bunion in the right foot that sometimes itches when she walks too much, but she wears comfortable shoes since many years ago. She remembers that, when she was young, she usually wore stilettos for going to work. Nowadays her feet get swollen and, especially when she lies down in bed, she feels formication in the calves and a throbbing sensation in the nape. Frequently this sensation is so intense that she cannot fall asleep. She rubs her legs and neck with warm cooking oil or Vick-Vap-o-rub or uses a hot water bottle to relieve the sensation. She has noticed that exercise helps to ameliorate these sensations, which, according to her doctor, are a sign of defective blood circulation. Soco started taking allopathic medicine to help with her circulatory problems but as she has not noticed any improvement she is not taking it anymore.

Other symptoms

Soco has had, for years, the sensation of a persistent mucus stuck in her throat, which she cannot spit out. She swallows it and then it comes back with a burning sensation. She takes a spoonful of honey with lemon to control this sensation for a while. Sometimes, the expectoration is so stuck in her throat that she cannot talk and gets coughing spells.

The ophthalmologist told her that she has cataracts in both eyes, but that there is no immediate need to operate them. She can read, although with some effort, and has no errors of perception with her surroundings.

Energy and sleep

She goes to bed usually at around 22:00 and watches the late news or other shows of her interest. She likes watching documentaries but her favourite programmes are the televised political debates which run up until midnight or later. At that time she turns off the light and sleeps until 8 or 9 in the morning.

Soco says that when she sleeps well, her best moment of the day is the morning. That is when she feels full of energy and her mind is clear. It takes her some time to sit on the bed, get on her feet, take the cane and go to the toilet. After going to the toilet, she goes back to bed and sleeps again until around 10. Then she gets up again and has breakfast. Usually she enjoys her meal, but even if she did not eat a lot, she feels pain and bloating in her abdomen and the sensation that she wants to release gas. She also feels restless, annoyed, and her energy starts going away. Then she feels compelled to go back to bed, read or watch some television, and sometimes falls asleep again. When I asked when her energy was at its worst, she said: in the evening.

Recent blood tests show that she is anaemic. She has been taking iron and injections of B12 and she claims there has been some improvement. The vitamins seem to help her to sleep better so that she feels rested in the morning. But invariably after breakfast, her energy starts dwindling. Soco sleeps surrounded by pillows in prone position. When she lies down on her back she feels that very disturbing throbbing on her nape.

Temperature

The patient is and has always been a very chilly person. She suffers from hypothyroidism and she thinks her chilliness might be due to this or to her anaemia. But she is not taking any medication for the thyroid condition. She tends to catch cold easily from exposure to cold wind or cold water, especially in her feet. She must wear socks and sleeps with a blanket when the weather is 29C, and sleeps with the windows shut and no fan, but with the curtains open. She does not like dark rooms. She does not perspire now and did not perspire much when young either. Only if she gets fever she sweats and that helps her to feel better. Frequently she feels feverish, especially in the afternoons, like catching a cold, but the thermometer shows normal temperature.

Appetite and thirst

Soco eats cooked vegetables, some meat and vegetable soup for lunch, and a piece of bread or a couple of corn quesadillas with a cup of herbal tea for dinner. She follows the Mexican custom of eating a hearty breakfast and the important meal between 14:00 and 15:00 hrs. Her dinner is usually very light. However, regardless of what she eats, her gut reacts with noise and gas. She takes vegetable carbon tablets (OTC) to ease the digestive process, after each meal, but the problem persists. She describes the abdominal pain as a burning pain.

The patient has always loved dairy products and spicy food. Nowadays she avoids both and this makes her quite unhappy. She also tries to avoid legumes because they produce flatulence. She eats one banana a day to avoid cramps in her legs. Since she cannot tolerate yoghurt, she drinks one Yakult a day. She doesn’t eat cakes, pastries or chocolates but she enjoys eating the local sweetened bread with molasses. She does not like fish nor seafood.

Soco drinks little sips of water all day long, as well as hot infusions made with lynx seed, or with fresh local herbs like linden flowers or chamomile. But she also likes carbonated drinks like apple soda and coke, because they help her with eructation. She used to enjoy one cup of weak coffee in the morning but recently her stomach does not accept it. She always takes drinks at room temperature, otherwise she gets sore throat, and prefers very hot drinks and very hot soups.

Mind

Soco is afraid of heights, snakes, scorpions, and earthquakes. But she claims to be a person able to control herself when her action is needed to help others. She lost her husband in 1988 from a massive heart attack which took his life in a matter of seconds. Her daughters claim that she recovered rather soon from this loss. Soco affirms that she has a strong religious faith and that she always knew that her husband had cardiac problems. Actually, she claims that she expected him to live less years than he actually did. She says that she had a happy marriage with him, despite the fact that he had a very strong and domineering personality. They had one son and two daughters. Her son died of complications from diabetes in December of 2014. When I asked her and her daughters how much this event had impacted her life, both concurred in that Soco was sad but relieved when her son died, because the year before his death he had lost one leg to gangrene, his kidneys were failing and he needed dialysis and 24/7 care. The son was a bachelor and Doña Soco felt that she had to take care of him but could not do it anymore. So, his death was a relief for her: “Now he is in the eternal light”, she says, “He is not suffering anymore”, and she keeps her eyes dry and her voice calm.

She and her family are familiar with homeopathy since many years ago, and she was prescribed sulphur 30C by a local homeopath, when her son died. She says that she felt very peaceful and strong through the wake and the funeral. Presently she is more focused in her future and says that she is fully aware that her end is near and that she is prepared to embrace it. However, as she keeps losing power and mobility, she fears she is becoming a burden for her family. She belongs in a local volunteer organisation which helps poor women to start micro enterprises and she still attends the meetings once a month. But she has stopped going to mass on Sundays because she has no one to take her to and back from the church. Presently she attends mass on television.

When I asked her if she wanted to add anything else, she thanked me for listening to her complaints for more than one hour and for asking her so many questions “in the way doctors used to do before”.

Initial assessment

We see a patient who, despite her advanced age, has the will to do things and remain connected with the world. However, her body prevents her from doing so. Her main complaint is not so much the physical pain she feels in the bones but her general lack of energy, which is better in the morning and diminishes after breakfast, when gastric, burning sensations set in. This lack of energy in combination with the GI bloating, prevents her from moving, which, in turn, increases her general discomfort. Soco provided useful information about her bone pains:

Location: Hips and lower limbs

Sensation: Bruising, blocking

Onset: Ten years ago, but markedly aggravated two years ago

Modalities:

Amelioration by exercise, walking slowly, stretching limbs while in bed or in warm water (pool), warm applications, rubbing, lying down and support (wearing an orthopaedic belt).

Aggravation by cold, in general; fatigue, standing up, sitting down or walking for more than 30 minutes.

The formication in the lower limbs and the throbbing in the nape are aggravated when lying down in supine position and ameliorated by warm rubbing.

The abdominal pain with bloating that follows eating almost anything, seems to be a concomitant symptom with the lumbar-sacral pains very marked in this patient.

This is a complex case, with a collection of old symptoms aggravated by the advanced age of the patient, a persistent anaemia and hypothyroidism, as well as the emergence of new symptoms resulting from the natural wear and tear of the musculo-skeletal system: curvature in spine and osteoporosis. However, the patient seems in good mental/emotional shape, is acquainted with homeopathy and keeps optimistic about improving her present state.

Repertorisation and remedy differential

The following rubrics were used to repertorise (Bönninghausen in Isis, Vision 2016):

Generalities, weariness, evening

Sensations, emaciation, atrophy in general

Sensations, emaciation of affected parts

Upper extremities lameness fingers

Abdomen, tympanites

Head throbbing occiput

Four remedies were considered from the resulting chart: Carbo vegetabilis, sulphur, bryonia and pulsatilla. All four include the general emaciation, the bloating in the abdomen and the throbbing sensations. However sulphur is hot and thirsty, while the patient is extremely chilly and drinks liquids not out of thirst but because she feels dryness in the mouth and throat. In this sense, pulsatilla would seem more indicated, however, pulsatilla is also a hot remedy that feels better in open air, and the patient dreads drafts of air and has to sleep in a warm and closed room. Bryonia, on the other hand, presents anxiety and restlessness in the evening and paralysis of limbs, however, in regards to temperature, it could be a hot remedy worse by dry cold wind, but it could also be chilly with increased thirst for very cold drinks. Whether hot or cold, bryonia is aggravated by heat and by the slightest movement, while the patient cannot tolerate cold drinks and must move in order to relieve her pains. Carbo vegetabilis has the icy coldness in the body and the restlessness in the evening; the paralytic weakness of fingers when grasping objects, as well as the paralytic weakness of legs. It also have extreme flatulence with frequent eructation, especially from fat food. Very characteristic of this remedy is the extreme chilliness with no thirst, with desire to be fanned. This desire for cold air together with the aggravation in the morning would be the only differentials with respect to the patient, but the rest of the symptoms match her picture. In addition, carbo vegetabilis is known for its marked action in the digestive tract, the venous circulation and the occiput, and is most indicated in exhausting diseases of old age (Boger, Clarke, Hering, Nash).

I chose carbovegetabilis since it covers the main complaints of this patient: the general lack of energy, the pain in the bones with lameness in extremities, the gastric problems as well as the sensation of throbbing in the nape. It also matches the thermals of the patient in a way none of the other remedies do: extreme chilliness with no thirst, yet constantly sipping liquids to avoid dryness in the mouth. Additionally, this remedy is strongly indicated in ailments of the old age where vital powers low, and the venous system is predominant (Tyler).

First follow up | December 16, 2016

At first glance the patient looked quite the same with no noticeable changes. During the interview she maintained good demeanour and her usual soft voice. When I asked about her symptoms she said she did not notice any major changes.

Lack of energy (main complaint) – no change

Pain in the lumbar and sacral regions – no change

Blockage in legs at the level of pelvic area – worse (she fell down twice)

Swelling of ankles and feet, aggravated at night and ameliorated by drawing the limbs up.

Assessment

Since the formication in limbs and nape and the burning in the stomach ameliorated but not the main symptom (lack of energy), I had to reconsider the remedy prescribed and refine my search using other rubrics:

Lower extremities: laming hip

Lower extremities: laming leg

Lower extremities: coldness of affected part

Lower extremities: tingling, muscles

Lower extremities: swelling foot

Eructation: loud, noisy belching

Sensations: weakness, exhaustion, prostration, infirmity

Mind: active, busy, inclined to work; thoughts

This time I concentrated in the lower limbs sensations and assumed that the lack of energy was an emergent property of the lack of mobility. I included, again, the gastric affection and the general sensation of weakness as well as one mental emotional rubric to support the choice of an appropriate remedy.

Pulsatilla and phosphorus were strongly suggested by the chart (Isis, Vision 2016). Both remedies have pain in the area of the hips, but pulsatilla has drawing weariness and heaviness in legs as well as swelling and weakness in the feet, aggravated in the evening. This remedy also has the tingling in the feet up to the calves which becomes worse at night, in bed, and is relieved by movement and by rubbing. Phosphorus also has swelling in the feet, as well as pain in the ankles as if sprained, but no formication or tingling. The patient does not complain from pain in the feet at night; but of numbness and formication.

The incarcerated gas in the abdomen, worse after eating, is a feature in both pulsatilla and phosphorus. However, in this latter remedy there are burning pains during flatulence and this modality has subsided in the case of the patient. Pulsatilla has flatulence and eructation without pain, thus in this respect it is a better match to the patient’s gastric picture. Another symptom covered by both remedies is the patient’s tenacious mucus in the throat, where phosphorus has also coughing.

In relation to the thermals of the patient, Soco must sip water all day because she has the sensation of dryness in the mouth but she does not feel thirst. This is consistent with pulsatilla but not with phosphorus, since the phosphorus patient has increased thirst and craves cold water and cold food, and our patient is better by warmth, hot liquids and hot food. Finally, pulsatilla covers the characteristic coldness in the bones of the patient, “as if wearing a pair of wet socks”, is the patient’s literal description, while coldness is not a key note in phosphorus.

The choice for pulsatilla became stronger when I found that it matched the genius of the patient in other respects: it is a remedy most indicated for cataracts, with good appetite but weak stomach that gets flatulence by eating fat food and even when, in fact, it does not match the temperature of the patient (pulsatilla is a hot remedy that ameliorates by fresh air and going outdoors), it seems suitable for the mental emotional picture of the patient: we have a restless person, with a mind full of projects, seeking for work to do and human company, with the desire to move around; with an energy that peaks in the morning and goes down in the afternoon and evening, with great chilliness and a feverish sensation—although the thermometer shows normal temperature. All these characteristics match the provings of pulsatilla in Allen and Hering.

The patient was prescribed pulsatilla 30C in watery doses, one sip in the morning for four weeks. I did not see her again but until after four months. By then she had moved to another city and was living in a senior’s residence.

Second follow Up | April 30, 2017

Soco has been living in a senior’s residence for four weeks. She seems happy and quite optimistic about the change. When I asked her about her previous and present symptoms, this is what she said to me:

Lack of energy – a little better

Pain in the lumbar and sacral regions – no change and worse walking

Blockage in legs at the level of pelvic area – no significant change

Formication in limbs and throbbing in nape – practically gone

Digestive problems (bloating and burning pain) – much ameliorated with a change of diet.

However, she reported two new symptoms:

Dizziness with a sensation as if sinking down, as if head were full of air; aggravated by any effort of raising the body from lying or a sitting position, and also from turning the head, and

Burning sensation in the soles of the feet, aggravated after ten minutes walking.

With her usual clear-mind, Soco explained that the dizziness was an old symptom that came and went over the years and that it started more than thirty years ago after a whiplash in her neck, during a car collision. The burning in the feet, however, was an utterly new symptom and it annoyed her very much because it prevented her from walking even during ten minutes.

The doctor of the residence prescribed her some ferrum tablets for the weakness and the dizziness. He assumed that her dizziness was a consequence of anaemia. However, Soco felt that the vertigo was related rather to the car accident. She had that sensation of her head being full of air, exactly like at the time of the accident.

When I asked the patient about any other changes in her life, she mentioned, of course, her moving into a new environment, which was impacting profoundly her habits. One of them was that she was unable to be up and about by 9, which was the time for breakfast. She mentioned that some of the residents went to the dining hall wearing their pyjamas, but she said she could never do that. Since it takes her a long time to get up, shower and get dressed, she was not willing to get up very early just to be on time for breakfast. Her family provided her with a small fridge and an electric kettle so that she could prepare herself a light breakfast in her own room.

One thing she said she really enjoyed at the residence was the massage she received from a nurse, twice a week. She also said that she felt much relieved because the throbbing in the occiput and the formication in her lower limbs were practically gone.

When I asked her if she noticed any change in her energy with the ferrum supplement, she said that in fact this substance was disturbing her stomach and felt that she wanted to stop taking it. However, she is aware of her lack of iron. In regards to shifts in appetite, temperature and sleep, Soco said that she was a bit concerned with the meals they served in the dining hall because sometimes they were too spicy for her stomach. About her temperature she said that she still is the usual chilly person of always, but that sometimes she feels too hot in her room, while in bed; so much so that she asked for an electric fan!

Other than that she said she felt very comfortable in her room and happy that she did not have to share it with anybody, so she could sleep with doors and windows closed, but with the curtains open. She added that she was sleeping very well and waking up in the morning, feeling rested and without pain. The problem started, when she walked for more than ten minutes, with the burning sensation in the soles. When I asked her what was her main complaint, this time she said: the dizziness.

In the mental/emotional aspect, Soco said that she felt happy to see people around her although she did not feel like making friends in there. She enjoyed being by herself in her room but she was also open to receive visitors. Overall, she claimed she had peace of mind because she was not a burden to her family anymore.

Assessment

There was improvement in the energy of the patient and a noticeable shift in her bodily temperature, which could also be related to her energy levels. Also, the GI problems subsided, partly, with a change in diet. However, the problems for walking remained and two new salient symptoms appeared: dizziness and burning in the soles of the feet. At this point it was difficult to know if the remedy prescribed had an effect in the shift of energy and temperature of the patient, since major events were happening in her life. However, the return of an old symptom and the absence of marked aggravation of the present symptoms made me think in that pulsatilla was still a suitable remedy, especially when I found out that pulsatilla has a marked action in vertigo as well as burning pains in soles of feet (Hering and Allen). I asked the patient to continue with pulsatilla 30C, one dry pellet in the morning.

Third follow up – July 20 2017

Soco looked her own pleasant and-easy-going self when talking about herself. This time she described her symptoms as follows:

Dizziness < turning head – still the same

Burning in abdomen – no longer an issue

Burning in soles of the feet – no longer an issue

Lack of energy – in general ameliorated but limbs still feel very weak

The patient claims that she feels much better, with more energy. She could walk now—with a walker or with a cane—from her bedroom to the chapel and to the dining room, without a helper. She made an appointment to have her eyes checked up and she is willing to undergo surgery to get rid of the cataracts. She expresses annoyance for not being able to read and write.

Soco says that she has fought anaemia for as long as she remembers. She was born to an anaemic mother in a country where the World Health Organisation estimates 60% of the population lacks iron (WHO, 2018). And although she has tried to take iron supplements several times, her stomach could never tolerate the collateral effects. Trying to prevent this, the resident doctor changed her prescription to Ferranina (an iron III-hydroxide polymaltose complex) for the anaemia, and vitamin C, to foster iron absorption. Differently from the ferrous sulphates she had tried before, this ferrum complex does not attach to plasma proteins and, hence, does not irritate the bowel membranes (Toblli & Brignoli 2007). Soco is happy that this supplement is not upsetting her stomach, and neither does the vitamin C. However, the same doctor prescribed her Diphenidol, for vertigo. This drug, asides disagreeing with her stomach, does not help with the dizziness, and Soco stopped taking it. All the while, she continues taking pulsatilla in the morning.

I did some research on Diphenidol and found something quite interesting. This drug is a synthetic agent that blocks the activity of the receptors of some proteins found in synapses and other cell membranes (Brown 1992, Soto & Vega 2010). The neurotransmitters involved here are muscarinic receptor antagonists which react against muscarine, a substance found in our agaricus muscaris! The way in which this drug prevents dizziness is by blocking the synapses of the autonomic nervous system that help to homeostasis at the vestibular level of the ear (Aronstam & Patil 2009, Hain & Uddin 2003, Hain & Yacovino 2005, Papparella 2014, Wrisley et al. 2000). Thus, the suppression of vertigo is expected to be accomplished. Diphenidol, by the way, is not available in Canada.

Agaricus muscaris did not appear in the chart when I repertorised the totality of characteristic symptoms of the patient, including dizziness. But in materia medica this remedy appears strongly associated with vertigo: when rising from bed or from sitting down (Clarke, Hering), and when turning the head (Allen). Although this symptom is also covered by pulsatilla, the picture of agaricus muscaris bears a strong resemblance with the picture of Soco:

Vertigo: when walking, reeling as if drunk; combined with a tottering gait and indistinct sight, even of near objects (Hering)

A number of head symptoms with stupefaction, dullness, sensation of air in head (Allen)

Heaviness, drawing and tension; heaviness towards nape (Hering)

Spinal affections >light touch (Nash)

Pain in sacrum >moving slowly (Nash)

Pains in limbs with lameness and numbness (Clarke, Hering)

Heavy and weary legs >walking slowly (Allen, Boger, Hering)

Coldness in legs (Allen, Hering)

Clumsiness, drops things (Hering, Kent)

Tympanic abdomen (Allen, Boger, Clarke, Hering, Kent)

Old people with indolent circulation (Hering)

Weakness in eyes, even without exertion (Allen, Clarke, Hering)

Extremely chilly; hugs the fire (Kent)

Burning in internal parts (Guernsey in Tyler)

Dryness of mouth (Allen, Hering, Kent)

Boger considers agaricus an allied remedy of pulsatilla, but then, I found a pearl in Hering: Follows well after pulsatilla.

If allopaths, according to their philosophy of antagonistic medicines, use a substance related to agaricus muscaris to block communication between the region of the brain which is connected to the vestibular ear where bodily balance is located, what if I prescribed the same substance, only homeopathically diluted and potentised, in the hope to precisely foster communication between those two regions of the brain/ear process?

I asked the patient to stop pulsatilla for two weeks and try agaricus muscaris 30C instead, in watery doses.

Fourth follow up | August 5 2017

The patient called me after one week to advice that the dizzy spells had subsided. Her energy levels had increased. She was organising a choir with her mate senior residents to sing Spanish Christmas songs at the end of the year festival. She was assisted by a helper during the day in order to get dressed, take a shower and have breakfast. Soco was sleeping very well and felt rested in the morning. No more throbbing sensation, no burning pains. Her stomach was still her weak point and she told me that she knew when she over indulged in food that did not agree with her economy. But, she added, she could not resist the temptation to eat spicy food or a bit of dairy every now and then. She was again very concerned with her locomotor problems and said that she was not walking as much as she wanted to.

Assessment

It seems that the patient could move around better with pulsatilla, but agaricus was actually ameliorating the vertigo. It is then that I started considering the alternation of both remedies. I prescribed pulsatilla 30C in watery doses, to be taken in the morning and agaricus muscaris 30C, also in watery doses, one sip at night, before going to bed.

Fifth follow up – January 13, 2018

When I met Soco again, another big change had happened in her life. For financial reasons, she had to leave the senior residence where she stayed for eight months, and moved back to her daughter’s house in the coast. She told me that, anyway, the food at the senior’s residence did not agree with her sensitive stomach and there was no way they could cook especial meals for her. Now she has helpers day and night, although she claims she does not need help during the night because she is sleeping very well and does not wake up to go to the bathroom. Besides, she finally agreed to use a diaper, just in case, and she can sleep peacefully.

Soco seems happy to be back home. She claims that living at the residence was a good experience, but that she feels much more comfortable back in her city, with her family and her friends close by. Her stomach, she says, is fine as long as she keeps controlling her cravings for spice and diary. Her assistant cooks for her and helps her with her everyday needs. In addition, the helper makes Soco walk every day, with the support of the walker. Soco stopped taking agaricus when the dizziness disappeared, and continued with pulsatilla, because now her chief complaint is, once again, her weakness.

Assessment

The original chief complaint is back, although the vertigo has disappeared. At this point I decided to go higher in potency. I prescribed pulsatilla 200C. But before the patient started taking it she caught a sudden cold. I prescribed belladonna 30C for her cold and after one week, she started taking pulsatilla again. Agaricus 30C, one dry pellet,was prescribed, in case the vertigo came back.

Sixth follow up – February 16, 2018

I received a call from Soco’s daughter: her mother had a fall after a dizzy spell. When I spoke with Soco, she seemed crestfallen. No broken bones, no major injuries, but she seemed very tired. “Maybe it is time for me to go”, she said. “I don’t want people to spend time and money in my case. I do not agree with suicide, but if medicines can’t do any more for me, I understand.” I asked for any new symptoms. She said that her pains kept moving from place to place, but that every day they were there, somewhere. After the fall she had been experiencing dizziness, like before: when lying down or getting up from bed, and when turning the head. Although she had started going again to the swimming pool downstairs, she feels nowadays that the wind is too cold for her and refrains from going, even with the helper. When I asked what made her feel better, her daughter answer: “Company”. She loves receiving guests at home; they bring her food and snacks and animated conversation. Then, Soco seems to forget about her pains. I asked the patient to go back to her routine of pulsatilla 30C in the morning and agaricus muscaris 30C in watery doses in the evening.

Assessment

When the patient stopped taking agaricus, the dizzy spells came back. After her fall, Soco felt dispirited and her mood was deeply affected. The chief complaint, lack of energy, also came back. However, the wandering pains and the general demeanour of the patient still point at pulsatilla and also to agaricus muscaris, as a complement.

Seventh follow up – April 4, 2018

I spoke on FaceTime with Soco. She looks her own self again. She is going to the swimming pool three times a week since the weather is warmer. Her dizziness stopped as soon as she restarted taking agaricus but her energy goes up and down. Some days are better than others.

She will undergo surgery for her cataracts in May and wants to know which remedy is appropriate to help her recover from surgery. She asks me how long she has to take the medicines. I tell her to watch for aggravations of any kind and call me when that happens. Otherwise she can continue taking the gentle cure, for as long as she needs.

Assessment

Definitely, this patient gets sensibly ameliorated by agaricus muscaris in alternation with pulsatilla. Since this is a chronic case gradually aggravated by age, I will have to keep monitoring the patient every three months and watch for any significant changes.